Healthcare Provider Details

I. General information

NPI: 1447538558
Provider Name (Legal Business Name): MEDARVA IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 WILKES RIDGE PKWY STE 100
RICHMOND VA
23233-7460
US

IV. Provider business mailing address

8700 STONY POINT PKWY STE 100
RICHMOND VA
23235-1962
US

V. Phone/Fax

Practice location:
  • Phone: 804-775-4500
  • Fax:
Mailing address:
  • Phone: 804-775-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TONYA JENKINS
Title or Position: VP
Credential:
Phone: 804-775-4500